Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers

• Published in: Journal of the American Academy of Dermatology 2020-10, Vol.83 (4), p.1057-1063
• Main Authors: Yélamos, Oriol, Manubens, Elena, Jain, Manu, Chavez-Bourgeois, Marion, Pulijal, Sri V., Dusza, Stephen W., Marchetti, Michael A., Barreiro, Alicia, Marino, Maria L., Malvehy, Josep, Cordova, Miguel A., Rossi, Anthony M., Rajadhyaksha, Milind, Halpern, Allan C., Puig, Susana, Marghoob, Ashfaq A., Carrera, Cristina
• Format: Article
• Language: English
• Subjects: basal cell carcinoma; Biopsy; Carcinoma, Basal Cell - diagnostic imaging; Carcinoma, Basal Cell - pathology; Carcinoma, Basal Cell - therapy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Clinical Decision-Making; Dermoscopy; diagnostic accuracy; diagnostic confidence level; Dysplastic Nevus Syndrome - diagnostic imaging; Dysplastic Nevus Syndrome - pathology; Dysplastic Nevus Syndrome - therapy; Female; Humans; Male; management; melanoma; Melanoma - diagnostic imaging; Melanoma - pathology; Melanoma - therapy; Microscopy, Confocal - methods; Middle Aged; Nevus, Pigmented - diagnostic imaging; Nevus, Pigmented - pathology; Nevus, Pigmented - therapy; Prospective Studies; reflectance confocal microscopy; Sensitivity and Specificity; Skin - pathology; skin cancer; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Watchful Waiting
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2019.05.101

Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P